Thousands of patients dying from incorrect use of IV drips warns Nice
National Institute for Health and Care Excellence says one in three patients die within days of surgery from too much fluid.
Patients’ lives are being put at risk by an “astonishing” lack of knowledge surrounding the correct administration of intravenous (IV) drips in hospitals in England and Wales, experts have warned.
The National Institute for Health and Care Excellence (Nice) has issued guidelines for medical practitioners on their use amid fears that tens of thousands of patients are suffering complications each year because most doctors do not know how to prescribe them properly.
There is a risk of pneumonia or heart failure if a patient is given too much fluid, or kidney failure if they are given too little.
Dr Mike Stroud, a gastroenterologist who chaired the group that developed the guidelines, said: “We are very confident that it has not been done well in the past and it needs to be done better … Doctors and other medical professionals are not well educated in terms of what a patient needs and that’s astonishing really … It is as important or more important than anything else in terms of making hospitals safer places.”
Stroud said that IV drips were probably the second most commonly used therapy in acute hospitals, and yet surveys suggested nine out of 10 doctors do not know the correct dosage and timing. He attributed the lack of knowledge to it not being a specialism. “This has fallen through the cracks because it’s no one’s baby,” he said.
Experts say it is difficult to pinpoint the consequences of mistakes, because most patients on a drip are also receiving other treatments. But Stroud estimates that tens of thousands of people are experiencing complications.
In 1999, the National Confidential Enquiry into Patient Outcome and Death said one in five patients on IV fluids and electrolytes suffered complications owing to inappropriate administration. In 2011, the same organisation found that a fifth of hospital patients who received too little fluid before surgery and a third who received excessive fluid died within 30 days of having their procedure.
The Nice guidelines say that hospitals should identify an IV fluids champion to be responsible for training, clinical governance and auditing, and monitoring patient outcomes, with incidents of fluid mismanagement reported.
Dr Jerry Nolan, a consultant in anaesthesia and intensive-care medicine who was part of the Nice guidance group, said the costs of implementing the guidelines, including training staff, would be more than offset by the reduction in complications. “We know that some elements of the undergraduate curriculum will include the physiology of fluids but it appears that there is some disconnect between what they learn at medical school and a lack of practical application when they become doctors,” he said.
“I think it is really important that healthcare professionals understand that fluids are effectively drugs, and just as is the case with any drug, the dose of fluid therapy is very important and that is something that is often being forgotten.”
Katherine Murphy, chief executive of the Patients Association, said: “It’s disgraceful that staff are allowed to go through their professional life without having the right training and support. The trust boards need to listen to this and treat it as a high priority. It’s all very well Nice coming up with the guidelines, but they need to be put into practice.”
In June, the use of starch drips in UK hospitals was suspended because the Medicines and Healthcare Products Regulatory Agency said that “their benefits no longer outweigh the risks” after it was found that the drips were linked to hundreds of unnecessary deaths.